| Granada Psychiatry L L C | |
|
1262 Aziz Dr Canton MI 48188-5094 | |
| (928) 785-7382 | |
| (734) 402-8987 |
| Full Name | Granada Psychiatry L L C |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1262 Aziz Dr, Canton, Michigan |
| Authorized Official Name and Position | Omar S Waqhar (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 7346732937 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Granada Psychiatry L L C 7422 S 50th St Franklin WI 53132-7714 Ph: (928) 785-7382 | Granada Psychiatry L L C 1262 Aziz Dr Canton MI 48188-5094 Ph: (928) 785-7382 |
| NPI Number | 1619728615 |
|---|---|
| Provider Enumeration Date | 03/28/2024 |
| Last Update Date | 06/25/2024 |
| Certification Date | 06/25/2024 |
| Medicare PECOS PAC ID | 4183166036 |
|---|---|
| Medicare Enrollment ID | O20240606001512 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619728615 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Omar Saud Waqhar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881081685 PECOS PAC ID: 0547562480 Enrollment ID: I20190814003508 |
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